The look in his eyes was unmistakable. His awkward and urgent disappearance from the hot tub having been noticed long before, the curious party-goers turned to meet his gaze as he crept silently yet conspicuously up to the sliding glass window separating the kitchen from the back patio; his attempt at stealth engendering empathy while provoking snickers from the herd. Though the steam rising from our perch in the warm bath in the already dimming light of dusk partially obscured our view, we knew by the visitor’s countenance that something had gone terribly awry while he was in the bathroom – his previously advertised destination. Brainstorming the possibilities for likely disaster scenarios in that location, and concluding that the list is short, all the while assessing his expression of horrified embarrassment, I reached two simultaneous conclusions: one, as his closest confidant among the group, he was furtively yet desperately soliciting my help with pursed lips and jerky nods of his head; and two, I was going to need a plunger.
As the end of one’s four-year medical school tenure approaches, thoughts and efforts turn towards the next step on the journey to doctor-hood: securing a residency. This is an apprenticeship of sorts during which new graduates become competent practitioners within their specialty of choice. Each one, pediatrics, internal medicine, interventional radiology, cardiothoracic surgery, orthopaedics, and others present their own unique challenges for admission. I often tell my patients that the only things required to score a residency position in orthopaedics is to graduate in the bottom half of your class and to be able to bench press your own weight. While this wry attempt at self-deprecation typically inspires a chuckle, as any physician will confirm, it is a gross and intentional misrepresentation of the fiercely competitive quest for such a coveted position.
In addition to leading the class in academic achievement, volunteering for research projects, publishing papers in peer-reviewed journals, and earning letters of recommendation from department chairpersons lauding one’s attributes as an ideal candidate, the orthopaedic hopeful must spend the latter half of his or her final year of school travelling the country and participating in “acting internships” at various programs. As much as this is a learning experience for the student, so is it an opportunity for the department’s existing members to evaluate the candidate; essentially, it is an audition. Therefore, the stress level during what is typically a month-long job interview can be daunting, and a flawless performance is the expectation. The acting intern must work hard, demonstrate knowledge, get to work early, leave late, and never complain. Additionally, he or she must not be a tool. A “tool,” by the way, is aptly defined by the Urban Dictionary as: “a person, typically male, who says or does things that cause you to give them a ‘what-are-you-even-doing-here’ look…The tool is usually someone who is unwelcome but no one has the balls to tell them to get lost…The tool is always trying too hard to fit in, and because of this, never will.”
Let us return to the night in question. We left our hero sulking at the sliding glass door, his visage one of unadulterated anguish. The last thing in the world I wanted to do at that moment was exit the toasty spa into the freezing winter air, abandoning my microbrew while attending to whatever the hell was going on with my new buddy. But my buddy he was – albeit a new one – and a nagging sense of duty washed over me as will happen when witnessing the humiliation of one’s brother-in-arms. I quickly grabbed a towel – hoping to minimize the biting chill to my exposed skin – and swiftly crossed the patio to the door. Sliding it open just enough to hear his plea, I mustered a less than sympathetic, “Dude, what?”
“I need your help, dude,” was his whispered reply through gritted teeth, and presented with only a trace of facial movement lest one of the other onlookers should read lips.
“What the hell happened?” I queried, alarmed by now that I knew the answer.
“Dude, is there a plunger here?”
Now, this was also the first time I had ever been to this particular house; the vacation home, by the way, of one of the attending surgeons at my orthopaedic residency program. And though I was no longer auditioning for a spot there, it was not my intention to make an ass of myself on this night. The professor – and forgive me if this bears no relevance – was a woman. That’s right. My man had come to a party during his audition, at the Lake Tahoe cabin of a female attending surgeon in the program of his dreams, and clogged the toilet.
It gets worse. His offering was – to put it delicately – a deuce. As I entered the tarnished lavatory, my eyes grew wide; for the problem was by no means isolated to the commode.
“Dude, what the f@#$!?” I gasped. The water still running, the floor beneath a half-inch of waste, and gagging at the stench, my incredulous mind was occupied by one prevailing certainty: “This poor bastard is never getting a spot in this residency.”
The five words no one ever wants to ask their host are: “Do,” “you,” “have,” “a,” and, “plunger.” But I took one for the team and made the awkward but necessary inquiry, thus negating our efforts at subterfuge. I will spare the reader the gruesome details. Needless to say, there was clean up involved.
My buddy did in fact land a spot in an excellent residency program, albeit not ours. I can’t say for sure that the plumbing mishap played a role in our departmental decision, but it likely didn’t help.
Medicine is a mine field; perfection is expected yet unattainable. Trial lawyers, administrators, colleagues, and medical boards have their sights trained on the big red target painted on our foreheads. Many physicians get fed up with any and all of the above and leave the field in disgust. I am writing in part to establish a backup career in case I reach the limit of my ability to constantly mount the zone defense that is required to stay afloat in this profession. For now, however, there are a few things that keep me in it. One is listening to kids describe their mechanisms of injury. With pressured speech and enthusiasm for detail, they include such inconsequential (to my treatment plan that is) elements of the story as: who was “it” in the game of tag they were playing when they fell and broke their wrist, or the name of their best friend. Another is asking a vet – often identifiable by a hat indicating the branch of military and war in which he served – about his experience; allowing as much time as desired to share a story or two. Admittedly, as indicated in many of my stories, I also find joy in the moments of absurdity encountered almost daily within the halls of medicine.